- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.16 / $3,000.00 / $11,093.00
| Facility | | $613.16 | $3,000.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,065.00 / $7,890.00 / $37,885.00
| Facility | | $3,065.00 | $7,890.00 | $37,885.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.15 / $773.70 / $834.54
| Facility | | $595.15 | $773.70 | $834.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,336.17 / $7,336.17 / $8,696.31
| Facility | | $7,336.17 | $7,336.17 | $8,696.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,526.00 / $14,460.00 / $19,962.00
| Facility | | $6,526.00 | $14,460.00 | $19,962.00 |